School Shooting as a Culturally Enforced Way of Expressing

Document Sample
School Shooting as a Culturally Enforced Way of Expressing  Powered By Docstoc
					                                        A N A L Y S I S         A N D     C O M M E N T A R Y

School Shooting as a Culturally
Enforced Way of Expressing
Suicidal Hostile Intentions
Antonio Preti, MD

Suicide with hostile intent encompasses a wide range of behaviors, from self-killing by methods that can harm
others, to the suicide that generally follows a spree-killing raid. Reports on school shooting, a highly dangerous and
lethal behavior that is spreading from North America to European countries, are analyzed within the paradigm of
suicide with hostile intent, with the purpose of discovering some elements that might prevent and limit the
dissemination of this behavior by imitation. In school shooting, the perpetrators often register a message before
their killing raid, as in an ancient form of suicidal assault, the devotio, that was widespread across ancient
Mediterranean Roman, Greek, and Hebrew cultures. The development of a code of rules to report on these
episodes, likely to attract the interest of the population for their bloody implications, could prevent the
dissemination of cultural norms that encourage this behavior.

J Am Acad Psychiatry Law 36:544 –50, 2008

Suicide with hostile intent encompasses a wide range                       shootings involve multiple intended or actual vic-
of behaviors, from self-killing by methods that can                        tims, often randomly targeted. While many spree-
harm others (use of explosives, car driving), to the                       killing episodes end up with the arrest of the perpe-
suicide that generally follows a spree-killing raid.1                      trators, or their deaths at the hands of local police
The major determinant of these forms of lethal be-                         authorities trying to subdue them, a large fraction of
havior, potentially or intentionally harmful to others,                    the documented school shootings have ended up
is the will to express rage toward those who are seen as                   with the perpetrators killing themselves. School
the source of one’s misfortune.2                                           shooting, therefore, often implies some suicidal in-
    Suicide by revenge was known in ancient times,3–5                      tention on the part of the perpetrators, who awaited
and now it is considered by current anthropological                        or planned the action with the purpose of commit-
and ethnological studies as being stimulated by cul-                       ting suicide after the execution of one or, generally,
turally approved rules that should earn the suicidal                       many victims. This scenario was proved beyond any
actor the support of the community in his or her                           doubt in the Columbine incident (Littleton, Colo-
efforts to obtain compensation for the suffered                            rado, April 20, 1999).8
wrongs.6,7 School shooting, a dramatic behavior that                          In this commentary, reports on school shooting
is becoming more and more frequent in North                                are analyzed within the paradigm of suicide with hos-
America, and is spreading in Europe, can be attrib-                        tile intent, to discover some elements that may pre-
uted in some way to the mechanics that govern sui-                         vent and, in particular, limit the dissemination of this
cide with hostile intent.                                                  behavior by imitation.
    The expression “school shooting” refers to firearm
violence occurring in educational institutions, espe-                      Evidence on School Shooting
cially the mass murder or spree killing of people
within such an institution. In most cases, school                             School shooting is an extremely rare event: there is
                                                                           not an agreed upon definition of what a case is, and it
Dr. Preti is Consultant Psychiatrist, Genneruxi Medical Centre, Fo-        is even more difficult to define nonevent cases for
rensic Consultant in Psychiatry, Cagliari Court, and Adjunct Professor     comparison.9 Because of the uncertainty about both
of Psychology, University of Cagliari, Cagliari, Italy. Address corre-
spondence to: Antonio Preti, MD, Centro Medico Genneruxi, via              the numerator and the denominator in studying
Costantinopoli 42, I-09129 Cagliari, Italy. E-mail:          school shootings, the extrapolation of causal path-

544                             The Journal of the American Academy of Psychiatry and the Law

Table 1 Episodes of School Shooting Since 1966
                                                                                                          Number of Cases Ending
             Number of Reported        Episodes by Year,    Number of Victims,     Number of Wounded,     With the Suicide of the
Location         Episodes                 on Average           on Average             on Average              Perpetrator(s)
US                    44              1.0 (1966 to 2008)           3.8                     6.3                   15 (34%)
Canada                 7               .2 (1975 to 2007)           3.4                     7.5                    4 (57%)
Europe                 7               .4 (1989 to 2008)           6.8                     8.5                    6 (85%)
Other                  5               .5 (1997 to 2008)           3.0                     2.2                    None
Reported in Wikipedia; updated as of May 29, 2008.

ways is a desperate concern for all those required to                  tional episodes, 5 in 2008 (all in February). The cor-
investigate the topic. Since a small number of cases                   responding events were three in Canada, four in Eu-
may be open to a large number of potential causes,                     rope, and three elsewhere. Roughly half of all
pattern matching has been the most frequent method                     episodes in these locations had occurred in the past
used to analyze school shooting scenarios.9,10 Pattern                 10 years. The number of victims ranged from 0 to 33
matching is the sole approach that can reduce the                      by episode in the United States, 1 to 14 in Canada, 0
degree-of-freedom problem, (i.e., too many variables                   to 17 in Europe, and 1 to 8 elsewhere.
to be investigated in too few cases). Indeed, while it is                 The number of wounded people ranged from 0 to
undoubtedly true that many hypothesized causal fac-                    31 by episode in the United States, 0 to 19 in Can-
tors also recur in many settings in which a school                     ada, 0 to 37 in Europe, and 0 to 6 elsewhere. On
shooting has not happened, negative cases are not                      average, there were more victims per episode, both
informative for identifying necessary but not suffi-                   murdered and wounded, in Europe than in the
cient factors (the first line in causation).                           United States or Canada.
   Data from Wikipedia were used to investigate the                       Often a single perpetrator was responsible for the
phenomenon; Wikipedia is rather accurate in de-                        killing, but sometimes more than one assailant was
scribing facts, at a level that has been equated to the                involved in the episode, as in the Columbine inci-
Encyclopaedia Britannica.11 Data were inspected on                     dent. The assault ended up with the perpetrator’s
April 25, 2008, and again on May 29, 2008. As a                        suicide more often in Europe than in the United
matter of fact, there is no alternative but to use media               States, Canada, or elsewhere. In the United States,
coverage such as that reported in Wikipedia to ana-                    the majority of events (60%) ended with the capture
lyze the phenomenon of school shooting, since these                    of the perpetrator(s).
deaths are not routinely reported to state or federal                     However, sometimes a suicide note was retrieved
agencies and cannot be identified by using traditional                 in cases in which the perpetrator was arrested or
public health or criminal justice data sources.12,13                   killed by police authorities in the course of the inci-
   A total of 44 episodes were listed to have occurred                 dent. Among those sentenced to prison, in some
in the United States from 1966 to 2008. Seven listed                   cases evidence of insanity was found, but details on
episodes occurred in Canada (from 1975 to 2007),                       this occurrence were not available for many of the
and 12 outside North America from 1989 to 2007                         episodes.
(Table 1). There were seven episodes in Europe
(three in Germany, and two in Finland), and five
occurred elsewhere (Australia, India, Argentina,                       Past Investigations on the Topic
Yemen, The Philippines).                                                  In a survey considering all episodes of school-
   The incidence of episodes was higher in the                         related violent deaths that occurred in the United
United States than elsewhere, with a robust trend                      States from 1992 to 1999, single-victim student ho-
toward an increasing number of episodes over time                      micides were found to have decreased significantly,
(about one episode every 10 years;             0.65, t                 while multiple-victim homicides increased.12 More
3.80, p .001, R2 43%, adj. R2 40%).                                    recent data, from 1999 to 2006, revealed a reversed
   Following the Columbine incident (April 20,                         pattern, with single-victim student homicides in-
1999: 15 victims), the bloodiest episode in the                        creasing and multiple-victim homicides decreas-
United States before the Virginia Tech massacre                        ing.13 In the 37 incidents investigated by the Secret
(April 16, 2007: 33 victims), there were 24 addi-                      Service’s National Threat Assessment Center within

                                                     Volume 36, Number 4, 2008                                               545
                                School Shooting as an Expression of Suicidal Intentions

the Safe School Initiative (SSI), all perpetrators (n            Concerns have been raised on the chance that sen-
41) were boys or young men.14                                 sational publicity about a violent crime or suicide
   Most of the victims were adolescents (mean and             may cause an increase in similar violent behavior.
median, 15 years; age range, 6 –18). In approxi-              Media guidelines have been proposed to reduce the
mately half of the incidents, one or more of the vic-         impact of this alleged copycat effect.22 Results seem
tims were targeted before the attack. In most, the            encouraging for decreasing copycat suicide.23
attacks were planned in advance.14                               Media coverage of school shooting, too, was re-
   More than 50 percent of school shooting events             ported to have been followed by an increase of threats
were preceded by some action that might have                  against schools. In the four weeks immediately after
warned of the potential for impending violence.10,12          the Columbine incident, for example, up to 350 stu-
More relevant to the intent of this article, homicide         dents were arrested in the United States on charges of
perpetrators were often found to have expressed sui-          having raised some kind of threat against a school.24
cidal behavior such as suicidal thoughts, plans, or           A study investigating imitative behaviors after the
actual attempts before the event, significantly more          Columbine incident found strong evidence of a
often than same-age homicide victims.12 Suicidal in-          copycat effect, with a bimodal increase, and then
tent was found in most cases for which there was              decrease, of threats (proportional to days of media
detailed information on the assailants.10,14                  coverage), mostly involving bombs (as in the Colum-
   Evidence indicates that, among students, homi-             bine episode) rather than guns or knives (as often
cide perpetrators were more than twice as likely as           found in school violence), with suburban and rural
their victims to have been bullied by their peers, and        counties more involved than urban ones.25
also were described as loners and poorly integrated              Copycat killing, therefore, may be a force behind
into school activities.12,14,15 Therefore, reasons of re-     the spread of school shooting throughout the West-
venge might have moved the perpetrator to kill. In a          ern world in the past 10 years. However, the key to
detailed case scenario inquiry, obtaining justice             prevention is discovering whether a subject poses a
against peers or adults was the principal stated motive       threat (i.e., she or he engages in behavior that indi-
by perpetrators, who were often angry about being             cates planning) and not merely whether he or she
teased or ridiculed and were looking for revenge              made a generic threat.14,26 Beyond copycat killing,
against specific individuals or groups.10 Revenge,            there could be additional mechanisms inherent in
however, was hardly ever acted upon impulsively: in           the behavior in itself, some culturally approved script
most of the ascertained cases, perpetrators prepared a        the perpetrator is following.
well-organized plan, and often communicated details
about it to acquaintances or friends, who failed to           On Killing by Self-Killing
report threats because they did not consider them                In more recent episodes of school shooting, the
serious or were embarrassed or ignorant of where to           perpetrator often registered a message before the kill-
go for help.16 The most antisocial peers sometimes            ing raid,27 as has become the rule in raid killings by
approved the plan, sharing the same anger against the         suicidal attacks in the Middle East.28 More recently,
stated target of violence.10,14                               some of these recorded messages were released on
                                                              public Web sites, such as YouTube, for other people
The Possibility of Copycat Killing                            to view, as occurred in the Jokela incident in Tu-
   Copycat killing has been suggested as a mecha-             usula, Finland (November 7, 2007).
nism in the spreading of school shooting in recent               This procedure is reminiscent of an ancient form
years, in both the United States and elsewhere.17 Like        of suicidal assault, the devotion, which was wide-
kittens, which learn by imitation, a copycat is some-         spread across Mediterranean cultures. Ancient Ro-
one who mimics the behavior of another. Copycat               man accounts describe a specific magic procedure
crimes were reported to follow violent episodes that          whereby a soldier was to invade the opponent’s camp
received wide coverage in the media: there is some            with the protection of the gods of the underworld
evidence on copycat homicides, where the perpetra-            and devastate the enemy troops. Many reports have a
tor copied the modus operandi of the imitated                 legendary flavor; however, historical documents re-
crime.18,19 There is also evidence on copycat sui-            port some episodes of self-killing by devotio that al-
cides, the so-called Werther effect.20,21                     legedly took place.29

546                       The Journal of the American Academy of Psychiatry and the Law

   Historians report a precise ritual that the soldier             runa Jivaro in Peru, and among the Fore, the Hagen,
consigning himself to suicide by devotio should com-               the Maenge, the Maring, and the Gainj of Papua
ply with. He should inform his fellows of his deci-                New Guinea.4,6,7 In these locations, popular narra-
sion, then speak a ritual formula including a curse                tives such as myths, legends, and folktales report ex-
against his enemies, and then throw himself against                plicit rules to accomplish suicide for revenge with a
the enemy pursuing the objective to kill as many                   good chance of punishing the offender. Generally,
enemies as he could during his raid.1,29 Obviously                 those planning suicides should warn the others of
enough, the assault always ended with the reaction of              their intentions and communicate, in advance, the
the opponent, who killed the assailant: suicide by                 identity of the individual who is responsible for their
aggression, the so-called provocation, was, indeed, a              gesture. Then, they should kill themselves in public.
choice often made by soldiers, particularly when de-               If individuals follow these procedures, then they can
feated.29 The same mechanism is now recognized in                  reasonably expect their kin and friends to seek either
the so-called suicide by cop, whereby someone en-                  revenge or payment for compensation by the of-
gages in life-threatening criminal behavior toward                 fender, thus denounced in public.7,33
law enforcement or civilians, aimed at provoking of-                   Recent episodes of school shooting, whereby the
ficers to shoot him or her in self-defense or to protect           perpetrator recorded a message and then dissemi-
civilians.30                                                       nated it through the Internet, indicate that school-
   A Jewish account of the Roman devotio tells of the              shooting perpetrators desire that other people under-
death of Eleazar during the battle of Bet-Sacharja, in             stand their reasons. These expectations indicate that
the Israeli-Seleucid war, reported in the Bible. To kill           the behavior is supported by a recurrent pattern,
the elephant carrying the enemy king, Eleazar ran                  which, in all likelihood, reflects culturally shared
through the enemy lines and spread death and fear,                 norms and is somehow expected to justify this kind
until he was killed by the falling elephant, which he              of behavior. As demonstrated by the episode that
had succeeded in eviscerating (I Maccabees 6:43–7).                recently occurred in Finland, the media and reports
Other episodes reminiscent of this procedure are re-               on the Internet could facilitate the diffusion of these
ported in Josephus’ Bellum Iudaicum (details in Ref.               potentially lethal norms. The development of a code
31). Some Greek historical accounts, too, are remi-                of rules to report on these episodes, which are likely
niscent of the devotio: in Xenophon’s Hellenika, and               to attract the interest of the population for their
in Pausania’s Description of Greece (details in Ref. 1).           bloody outcomes, could prevent the dissemination of
While these procedures are intended to be military,                cultural norms that might encourage this behavior.
they are characterized by the commitment of the ac-
tor to his goal, killing as many enemies as possible by            Facing the Menace
sacrificing himself, and the cultural recognition his                 School shooting, per se, is a very rare event. There
action was expected to receive in the community.                   are many more challenging violent threats in the life
                                                                   of young people and their families. However, a single
Suicide with Hostile Intent                                        event can have an enormous and enduring impact on
   Particularly in the incidents that ended with the               all those who are exposed to it.34 The personal expe-
suicide of the perpetrator, the messages sometimes                 rience of violence for most children and adolescents
recorded before the killing raids reported revenge as a            occurs at school.35,36 Being involved or witnessing an
reason for the planned mass killing, although in some              episode of school shooting can result in long-stand-
cases these reasons were mixed with delusional                     ing post-traumatic stress disorder, negatively affect-
themes, leaving some doubt on the real basis of the                ing the maturational course.37 Negative conse-
pretended wrongs that allegedly moved the actor to                 quences were described for involved adult staff as
revenge.32 In the instances of suicide with hostile                well.38 School shooting can also have a disrupting
intent, sometimes revenge is taken by stirring a social            effect on class cohesion,25 while school connected-
reaction against those individuals who the commu-                  ness was found to be protective against violence per-
nity thinks have caused the suicide.1–3                            petration in some studies on minorities.39,40
   The ethnographic literature reports that suicide                   Risk assessment is very difficult for violence in
for revenge is widespread in preindustrial cultures, as            general,41 and for rare events such as school shooting
it was described among the Zaire in Africa, the Agua-              in particular.42 There is no reliable method to predict

                                            Volume 36, Number 4, 2008                                                 547
                                      School Shooting as an Expression of Suicidal Intentions

Table 2 Warning Signs in School Shooting Incidents
Predicted on the Basis of Past Studies*              Occurred in Real Case Scenarios†                    High-Risk Factors
Uncontrolled anger                             Threats of violence                             Recent history of violence
History of aggression                          Detailed plan, often communicated to others     Past history of violence
Threats of violence                            Blames others for problems                      History of suicidal behavior
Recent loss                                    History of aggression                           Family history of violence
Symptoms of depression/hopelessness            Uncontrolled anger                              History of substance abuse
Social isolation (real or perceived)           Depression and/or suicidal threats              Medical condition
Feelings of being persecuted or bullied        Poor coping and social skills                   Use of medication
Access to firearms                             Feelings of being rejected by peers             Access to and experience with weapons
                                               Feelings of being persecuted or bullied         Recent loss
                                               Access to firearms                              Recent humiliation
                                               Fascination with weapons and explosives         Communication of violent intentions
                                               Organized for attack
                                               Lack of a prosocial support system
                                               Recent loss
                                               Lack of supervision at home
*Extracted from References 41 and 44.
†Extracted from Reference 14, and Reference 10, p 43.

future violence, and there is a high risk of both false                    As for suicidal behavior, a yet unknown fraction of
positives and false negatives, which raises questions                   suicides are intended to avenge a wrong that the per-
of ethics (loss of individual freedom and privacy),                     petrator feared would never be legally prosecut-
and the more pragmatic problem of avoiding a pejo-                      ed.1,7,33 A link between aggressiveness and suicidal
rative trajectory in the life of wrongly identified po-                 thoughts has been repeatedly reported and is partic-
tential offenders (i.e., a self-fulfilling prophecy, with               ularly evident among youths.48
a wrongly identified subject developing persecutory                        People with a history of trauma are more prone to
thoughts about authority).10,43                                         suicidal thoughts and plans.49 Suicidal thought and
   There is some agreement on risk factors for aggres-                  intent to gain revenge may become a lethal admix-
sion and violence to recur along a continuum, with                      ture when adolescents and young adults have access
accumulating risk factors, hence a greater number,                      to firearms.9,14,50
indicating greater risk.16,44 Some elements were in-
dicated to deserve greater attention, in the presence
of increasing levels of risk: a history of aggression, a                Guidelines for Prevention
decline in functioning, and a recent relational loss or                    The prevention of copycat school shooting rests
stressful event make the case for additional inquiry,                   on the adoption of precise guidelines for the report-
particularly after openly disclosing threats of suicide                 ing of the episodes.25 As for media-coverage guide-
or targeted violence (Table 2). Specific guidelines                     lines,21 exposure should be given to preventable ele-
have been released in the United States for this pur-                   ments in the episode. For example, when there is
pose,26 but they are lacking in other countries.                        evidence of mental disorder in the perpetrator, it
   Social isolation and peers’ rejection, particularly                  could be appropriate to state this and set standard
bullying victimization, have been associated with                       rules for dealing with mental troubles, such as con-
most incidents analyzed in the United States.14,45                      tacting a counselor within the school or receiving
Risk factors for bullying victimization and for sui-                    addresses for mental health examination and includ-
cidal behavior should be taken into account in deal-                    ing telephone numbers of help lines or Web sites for
ing with interpersonal school-associated violence.                      receiving help when suffering the effects of mental
Past studies have shown that bullied victims some-                      distress. The plain description of symptoms should
times retaliate in a highly aggressive manner to pro-                   be used: clear terms, such as depression, anxiety, hal-
vocative bullying.46,47 Acting against bullying and                     lucinations, or suicidal ideation are preferable to stig-
harassment in school and fostering a culture of mu-                     matizing words like madman, crank, or nut, which
tual respect and help is the main recommendation                        prevent identification.
that emerged from the Safe School Initiative (SSI)                         The perpetrator should never be glorified, but nei-
team.26                                                                 ther should he or she be demonized, to avoid glorifi-

548                             The Journal of the American Academy of Psychiatry and the Law

cation by rebellious countercultures. Information on                              15. Leary MR, Kowalski RM, Smith L, et al: Teasing, rejection, and
                                                                                      violence: case studies of the school shootings. Aggress Behav 29:
methods of killing should never be fully disclosed.                                   202–14, 2003
   Finally, the importance of referring students or                               16. Fein RA, Vossekuil B: Assassination in the United Sates: an oper-
staff members with mental troubles to appropriate                                     ational study of recent assassins, attackers, and near-lethal ap-
                                                                                      proachers. J Forensic Sci 44:321–33, 1999
services should be emphasized in seminars devoted                                 17. O’Toole ME: The School Shooter: A Threat Assessment Perspec-
to educators and chief directors. Many people with                                    tive. Quantico, VA: National Center for the Analysis of Violent
mental disorder are not violent or aggressive. How-                                   Crime, FBI, 2000
                                                                                  18. Anonymous: Psychic contagion of criminal impulse. JAMA 49:
ever, some people with psychosis and additional                                       601–2, 1907
risk factors (substance abuse, recent trauma, or a                                19. Cohen A: Criminals as copycats. Time 153:38, 1999
stressful event), can be very dangerous, and this pos-                            20. Philips DP: The influence of suggestion on suicide: substantive
sibility should not be overlooked because of a mis-                                   and theoretical implications of the Werther effect. Am Sociol Rev
                                                                                      39:340 –54, 1974
taken spirit of benevolence toward subjects who                                   21. Stack S: Media coverage as a risk factor in suicide. J Epidemiol
are mentally ill.51 These subjects may need treat-                                    Community Health 57:238 – 40, 2003
ment, even against their will, and they have the right                            22. Etzersdorfer E, Sonneck G: Preventing suicide by influencing the
                                                                                      mass media reporting: the Viennese experience, 1980 –1996. Arch
to receive appropriate care, even when they cannot                                    Suicide Res 4:67–74, 1998
give adequate informed consent because of their                                   23. Niederkrotenthaler T, Sonneck G: Assessing the impact of media
mental state.                                                                         guidelines for reporting on suicides in Austria: interrupted time
                                                                                      series analysis. Aust N Z J Psychiatry 41:419 –28, 2007
                                                                                  24. Drummond S, Portner J: Arrests top 350 in threats, bomb scares.
References                                                                            Education Week on the Web. 18:12–14, 1999. Available at http://
 1. Preti A: Suicide to harass others: clues from mythology to under-        Ac-
    stand suicide bombing attacks. Crisis 27:22–30, 2006                              cessed May 29, 2008
 2. Preti A: On killing by self-killing: suicide with a hostile intent.           25. Kostinsky S, Bixler EO, Kettl PA: Threats of school violence in
    Etudes sur la mort: Thanatologie 130:89 –104, 2006                                Pennsylvania after media coverage of the Columbine High School
 3. Delcourt M: Le suicide par vengeance dans la Grece ancienne.
                                                         `                            massacre: examining the role of imitation. Arch Pediatr Adolesc
    Revue de l’Histoire des Religions CXIX:154 –71, 1939                              Med 155:994 –1001, 2001
                                                                                  26. Fein R, Vossekuil B, Pollack W, et al: Threat assessment in
 4. Jeffreys MDW: Samsonic suicide or suicide of revenge among
                                                                                      schools: a guide to managing threatening situations and to creat-
    Africans. African Studies 11:118 –22, 1952
                                                                                      ing safe school climates. Washington, DC: U.S. Department of
 5. Preti A, Miotto P: Suicide in classical mythology: cues for preven-
                                                                                      Education, Office of Elementary and Secondary Education, Safe
    tion. Acta Psychiatr Scand 111:384 –91, 2005
                                                                                      and Drug-Free Schools Program and U.S. Secret Service, Na-
 6. Johnson PL: When dying is better than living: female suicide
                                                                                      tional Threat Assessment Center, 2002. Available at www.secret-
    among the Gainj of Papua New Guinea. Ethnology 20:325–34,
                                                                             Accessed May 29, 2008
                                                                                  27. Gibbs N, Roche T: The Columbine tapes. Time. December, 12,
 7. Counts DA: Female suicide and wife abuse in cross cultural per-                   1999. Available at
    spective. Suicide Life Threat Behav 17:194 –204, 1987                             0,9171,992873,00.html. Accessed May 29, 2008
 8. Block JJ: Lessons from Columbine: virtual and real rage. Am J                 28. Grimland M, Apter A, Kerkhof A: The phenomenon of suicide
    Forensic Psychiatry 28:5–33, 2007. Available at                   bombing: a review of psychological and nonpsychological factors.
    block.columbine.6.5.07.pdf. Accessed May 29, 2008                                 Crisis 27:107–18, 2006
 9. Harding DJ, Fox C, Mehta JD: Studying rare events through                              ´
                                                                                  29. Grise Y: Le suicide dans la Rome antique [Suicide in ancient
    qualitative case studies: lessons from a study of rampage school                  Rome]. Paris: Les Belles Lettres, 1982
    shootings. Sociol Methods Res 31:174 –217, 2002                               30. Hutson HR, Anglin D, Yarbrough J, et al: Suicide by cop. Ann
10. Verlinden S, Hersen M, Thomas J: Risk factors in school shoot-                    Emerg Med 32:665–9, 1998
    ings. Clin Psychol Rev 20:3–56, 2000                                          31. Preti A: Suicide with hostile intent in the Bible. Acta Psychiatr
11. Giles J: Special report: internet encyclopaedias go head to head.                 Scand 113:237, 2006
    Nature 438:900 – 01, 2005                                                     32. Lee J, Lee T-S, Ng B-Y: Reflections on a mass homicide. Ann Acad
12. Anderson M, Kaufman J, Simon TR, et al: School-associated vi-                     Med 36:444 –7, 2007
    olent deaths in the United States, 1994 –1999. JAMA 286:2695–                 33. Hollan D: Indignant suicide in the Pacific: an example from the
    702, 2001                                                                         Toraja Highlands of Indonesia. Cult Med Psychiatry 14:365–79,
13. CDC: School-associated student homicides: United States, 1992–                    1990
    2006. MMWR Morb Mortal Wkly Rep 57:33– 6, 2008                                34. Fredland NM: Nurturing hostile environments: the problem of
14. Vossekuil B, Fein RA, Reddy M, et al: The final report and                        school violence. Fam Community Health 31(Suppl 1):S32–S41,
    findings of the Safe School Initiative: implications for the pre-                 2008
    vention of school attacks in the United States. Washington,                   35. O’Keefe M: Adolescents’ exposure to community and school vi-
    DC: U.S. Department of Education, Office of Elementary and                        olence: prevalence and behavioral correlates. J Adolesc Health
    Secondary Education, Safe and Drug-Free Schools Program                           20:368 –76, 1997
    and U.S. Secret Service, National Threat Assessment Center,                   36. Samms-Vaughan ME, Jackson MA, Ashley DE: Urban Jamaican
    2002. Available at Accessed May 29,                   children’s exposure to community violence. West Indian Med J
    2008                                                                              54:14 –21, 2005

                                                        Volume 36, Number 4, 2008                                                                  549
                                        School Shooting as an Expression of Suicidal Intentions

37. Campbell C, Schwarz DF: Prevalence and impact of exposure to           45. Harpold JA, Band SR: Lessons learned: an FBI perspective: school
    interpersonal violence among suburban and urban middle school              violence summit. Little Rock, AR: Behavioral Science Unit, FBI
    students. Pediatrics 98:396 – 402, 1996                                    Academy, 1998
38. Schwarz ED, Kowalski JM: Malignant memories: reluctance to             46. Olweus D: Bullying at school: basic facts and effects of a school
    utilize mental health services after a disaster. J Nerv Ment Dis           based intervention program. J Child Psychol Psychiatry 35:1171–
    180:767–72, 1992                                                           90, 1994
39. Bearinger LH, Pettingell S, Resnick MD, et al: Violence perpetra-      47. Pellegrini AD, Bartini M, Brooks F: School bullies, victims,
    tion among urban American Indian youth: can protection offset              and aggressive victims: factors relating to group affiliation and
    risk? Arch Pediatr Adolesc Med 159:270 –7, 2005                            victimization in early adolescence. J Educ Psychol 91:216 –24,
40. Cernkovich SA, Giordano PC: School bonding, race, and delin-
    quency. Criminology 31:261–91, 1992
                                                                           48. Miotto P, De Coppi M, Frezza M, et al: Suicidal ideation and aggres-
41. Borum R, Fein R, Vossekuil B, et al: Threat assessment: defining
    an approach for evaluating risk of targeted violence. Behav Sci Law        siveness in school-aged youths. Psychiatry Res 120:247–55, 2003
    17:323–37, 1999                                                        49. Flannery DJ, Singer MI, Wester K: Violence exposure, psycho-
42. Mulvey EP, Cauffman E: The inherent limits of predicting school            logical trauma, and suicide risk in a community sample of dan-
    violence. Am Psychol 56:797– 802, 2001                                     gerously violent adolescents. J Am Acad Child Adolesc Psychiatry
43. Grisso T, Appelbaum PS: Is it ethical to offer predictions of future       40:435– 42, 2001
    violence? Law Hum Behav 16:71– 83, 1992                                50. McNabb SJ, Farley TA, Powell KE, et al: Correlates of gun-
44. Fein RA, Vossekuil B, Holden G: Threat assessment: an approach             carrying among adolescents in south Louisiana. Am J Prev Med
    to prevent targeted violence. Research in Action. Washington,              12:96 –102, 1996
    DC: U.S. Department of Justice, Office of Justice Programs, Na-        51. Tanay E: Virginia Tech mass murder: a forensic psychiatrist’s
    tional Institute of Justice, 1995                                          perspective. J Am Acad Psychiatry Law 35:152–3, 2007

550                              The Journal of the American Academy of Psychiatry and the Law

Shared By: